The effect of botulinum toxin A on the function if a person with poststroke quadriplegia

The purpose of this case report is to describe a 50-year-old man, who was 5 months post-brain-stem infarction, before and after botulinum toxin A injections to the biceps brachii and quadriceps femoris muscles. Prior to the injections, he exhibited quadriparesis and involuntary movements of the limbs in directions opposite to those that were being volitionally attempted. For example, as he began to reach with his arms (extend his elbows), his elbows would flex, and when he attempted to flex his legs, they would extend. The patient was evaluated prior to the injections, after the botulinum toxin A injections and 2 weeks of intensive inpatient rehabilitation, and 6 weeks after injections. Evaluations included the Functional Independence Measure (FIM), the Sickness Impact Profile (SIP), and evaluations of walking, bed mobility, and transfers. Prior to the injections, the patient walked 9.1 m (30 ft) with a bilateral platform walker and required total assistance for toilet transfers and maximal assistance for walking and for bed, chair, and wheelchair transfers. Levels of assistance were those defined by the FIM. After the injections and 2 weeks of rehabilitation, he walked distances greater than 45.7 m (150 ft) with one platform on his walker, required maximal assistance for toilet transfers, and required minimal assistance for walking and for bed, chair, and wheelchair transfers. Walking speed, FIM scores, and six areas of the SIP improved 2 and 6 weeks after injections.